Structure, organization, and practical functioning of the sports cardiology center of the Nemocnice Agel Trinec Podlesi

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiological care of athletes worldwide is focused on prevention of cardiovascular disease, diagnosis, and follow-up of abnormalities in preventive screening, and subsequent therapy of detected pathologies with risk assessment for sport. The Czech Society of Sports Medicine and the Czech Cardiology Society responded to this process by establishing sports cardiology centers in the early 2020s. The centers were established in Olomouc, with two centers in Prague and Trinec.

Structure and organization

The Trinec Centre of Sports Cardiology (CSK) is organized based on tribal doctors of the Cardiocentre of the Agel Třinec-Podlesí Hospital and external cardiological collaborators from Silesia and Moravia. These doctors are trained in sports cardiology.

The practical functioning of the center is based on gradual steps: A) The patient logs in to our way through the web interface, where the essential information and previous examinations are given. B) The center's coordinator will incorporate these input data, will ensure communication with the client, other necessary information or examination, and after consultation with cardiologists, who subspecialize in the subunits, will establish a treatment plan. C) The CSK nurse ensures the organizational aspects of the established procedure. D) After the follow-up examination, the client has a final consultation with the sports cardiologist, where the suitability or limitations for sport and other recommendations for dispensation are always indicated. See Figure 1.

Cohort of athletes

Retrospective analysis of athletes from 1/2020 - 10/2021: 71 athletes, 26.0 +/- 1.5 years (15-61), 10 females (16%)/61 males: sport type: Endurance 31%, Mixed 66%. Most common indication: 46% coming in for abnormal preparticipation screening. At the conclusion of the investigation, only two were ineligible for sport, 32 eligible with condition

Conclusion

Structured, well-organized, and high-quality cardiac care for athletes is the main focus of the centers' work. In addition, the vision of our center is to provide tertiary cardiac care for athletes to reduce the risk of health complications in athletes. Therefore, our department is targeting EAPC accreditation for a sports cardiology center.

Intracoronary streptokinase versus intravenous anisoylated plasminogen streptokinase activator complex in the treatment of acute myocardial infarction

As part of a randomised multicentre study, 16 patients with acute myocardial infarction were treated with either anisoylated plasminogen streptokinase activator complex (APSAC) administered as an intravenous bolus of 30U or 250,000U of streptokinase by the intracoronary route. The reperfusion was documented angiographically during a 90-minute period and possible reocclusion was assessed at 90 minutes and 24 hours after the start of therapy. The percentage of reperfusion obtained in the APSAC group was 83% versus 63% in the streptokinase group. One reocclusion was seen after 24 hours in the APSAC group. Fibrinolytic activity was more pronounced in the APSAC group but there were no major bleeding problems in either group. The administration of 30U of APSAC by an intravenous bolus injection produced results at least as good as those obtained with intracoronary streptokinase and in addition offered the advantage of a simpler and quicker administration.

Selective intracoronary thrombolysis in the coronary care unit without cineangiography

Selective coronary artery visualization was performed in the CCU by means of a movable fluoroscopy device in 96 patients with suspected myocardial infarction within 6 hours after onset of symptoms. Intracoronary streptokinase (SK) was administered in a total dosage of 200 000 to 400 000 U within 30-60 min to 69 patients with complete (N = 57) or subtotal obstruction (N = 12) of the infarct-related vessel. Recanalization was achieved in 39 of the 57 patients (68%) with initially complete occlusion. Three of the 39 successfully treated patients died (7.7%) versus 8 of 33 subjects (24%) with persistent complete obstruction (chi-square 3.21, not significant). Selective cineangiography subsequently performed in 8 patients and postmortem examination of 12 subjects who had died, showed that all haemodynamically significant lesions had been recognized by the examination in the CCU with one exception. It is concluded that intracoronary thrombolysis performed in the CCU, by means of a standard mobile fluoroscopy equipment is effective, safe, inexpensive and may be started virtually without delay after admission.